“Even if EHRs reduce the risk of errors overall, they may produce entirely new ones, Edward Fotsch, CEO of PDR Network, which will provide network operations for the new reporting system, tells the Health Blog. For example, EHRs may cut the risk of failing to alert a patient to an abnormal test result, but confusing user interfaces may produce their own mistakes and need tinkering.”
“Even with these differences, a human can rapidly determine that they refer to the same individual for two reasons. The first is that the values that differ across the pair of records are not too different from each other, and the second is that there seems to be enough support from across each pair of attributes to assert some degree of similarity.”
“Today, everything seems to be moving into the cloud. In 2005, investment in cloud computing was about $26 million. But in 2009, the investment grew to $370 million, more than 10 times of what was invested in 2005.”
“Some of the nation’s largest banks are exiting or scaling back their dealings with foreign embassies and missions in the U.S. because of the burden of complying with money-laundering regulations… ‘It’s a commercial decision, but clearly it has ramifications for diplomatic relations,’ said Mark Toner, acting deputy spokesman for the State Department. ‘We want these foreign missions to be able to carry out their normal diplomatic functions here in the U.S.’”
“There are an estimated 50 million patient records, with 20 to 200 records per patient, resulting in billions of individual pieces of information, all of which need entity resolution: in other words, which records belong to her, him or somebody else.”
“According to the Centers for Medicare and Medicaid Services, the program made nearly $24 billion in improper payments in 2009, almost doubling the previous years’ rate. The price of fraud, however, runs even higher. A CBS report notes that Medicare fraud costs taxpayers an estimated $60 billion a year, and some estimates put the figure at nearly $100 billion.”
“For the last two years, respondents to our survey have cited several information management-related problems among the top barriers to adopting BI tools company-wide. Data quality problems are cited most often, by 55% in both 2009 and this year, followed by ease-of-use challenges, and integration and compatibility with existing platforms. Among the people directly responsible for information management, the biggest impediments to success are accessing relevant, timely, reliable data (59%); cleansing, deduping, and ensuring consistent data (51%); and integrating data (49%).”
“Billions of your tax dollars are lost every year to healthcare fraud. In fact, the tab is $36Million a day for Medicare fraud alone. U.S. Congressman Michael Burgess of Lewisville watched FOX 4’s undercover investigation in to the practices of a home health care recruiter. Today, FOX 4’s Becky Oliver spoke with Congressman Burgess.”
“In just the last fiscal year, we obtained settlements and judgments of more than $2.5 billion in False Claims Act matters alleging health care fraud. This marked a new record – and an increase of more than 60 percent from fiscal year 2009. We also opened more than 2,000 new criminal and civil health-care fraud investigations, reached an all-time high in the number of health-care fraud defendants charged, stopped numerous large-scale fraud schemes in their tracks, and returned more than $2.5 billion to the Medicare Trust Fund and more than $800 million to cash-strapped state Medicaid programs.”
“Gartner reports that due to the sluggish economy, customer demand for MDM software is growing at a significantly slower rate than years past. But it is growing. The analyst firm predicts that the overall market for MDM software will increase from $1 billion in 2008 to $2.9 billion by 2013. Gartner also predicts that by 2010, investments in MDM software will lead to an 80% reduction in costs associated with managing redundant data.”
“Some of the nation’s 72 fusion centers–where federal, state, and local law enforcement agencies share data on terrorism and crime threats–may face budget problems in the nation’s tough economic conditions. Ross Ashley of the National Fusion Center Association, which represents the centers, says that some newly elected governors must be convinced of the centers’ worth. The agencies typically do not have line-item budgets and are dependent on allocations from various levels of government to operate.”
“On November 1, the Secure Flight program achieved a key goal as described on the Transportation Security Administration (TSA) web site: Secure Flight, the Transportation Security Administration’s (TSA) behind-the-scenes watch list matching program, fulfills a key recommendation of the 9/11 Commission by assuming responsibility of watch list matching from individual airlines. By establishing a consistent watch list matching system, Secure Flight enhances aviation security and more effectively facilitates air travel for passengers.”
“With a simple text message system you can bring the power of a supercomputer to the cheapest and simplest mobile phones via cloud computing. For many important applications there is no need to place supercomputing power in the device itself. Simple cell phones can act as smart phones today, thanks to the cloud. That’s an amazing technological advance.”
“The hospital, according to Field, allegedly paid a doctor $12,000 a month in Medicare money to serve as a medical director and to get patients admitted into a nonexistent program for women with post-traumatic stress disorder. Field also alleged the hospital billed Medicare for services to psychiatric patients without the doctor certification statements required by the government. ‘In essence it appeared that what the hospital was doing was obtaining reimbursement from the federal government for medically unnecessary psychiatric services,’ Assistant U.S. Attorney Lisa Palombo said.”
“‘He has taken no responsibility for his conduct,” Kamiabipour said. ‘When he gets out, he’ll do it again.’ Petronella’s attorney, Tom Dunn, said the sentence was fair, though he would have liked to see his client get less time. Dunn also commended the judge for his “thoughtful and sound” decision on restitution. State officials and prosecutors say the couple operated a $38 million workers’ compensation insurance-fraud scheme.”
“In addition to 12 years in state prison, Montes was ordered to pay more than $1.7 million in restitution with more than $286,000 ordered for FTB for failing to file and report almost $1.5 million in income relating to the insurance fraud during the years 2004, 2005 and 2006.”
“The DHS Office of Intelligence and Analysis, where I serve, takes information and intelligence from across DHS and the national Intelligence Community, processes and analyzes it, and then shares it with the fusion centers, often in joint products with the FBI. The fusion centers then disseminate it to the some 18,000 state, local, tribal, and territorial law enforcement organizations, and to thousands more first responders throughout the country.”
“Federal laws require banks to know who exactly they’re doing business with - identification checks are mandatory - and they must gather details of clients’ backgrounds and lives. Failure to comply with those regulations can lead to administrative and criminal charges. Banks and other businesses that handle cash also are required to report suspicious transactions involving their clients to a federal anti-money laundering agency, FINTRAC. Reporting failures can also lead to administrative penalties and criminal charges.”
“Specifically, there were 145 FCA cases settled in the 2010 fiscal year and the 10 largest settlements involved health care fraud, with eight involving drugmakers, according to Taxpayers Against Fraud, a non-profit that supports whistleblower lawsuits. The 10 largest cases accounted for $2.7 billion recovered. Although fiscal year 2009 actually recovered a larger pot of money - $5.6 billion.”
“It’s no longer too scandalous or surprising to admit that technology- or IT-centric MDM strategies just don’t work. Building a single version of truth of master data in a central hub somewhere doesn’t directly solve any business problems. The only way master data can reduce risks, improve operational efficiencies, reduce costs, increase revenue or strategically differentiate an organization is by figuring out how to connect and synchronize that master data into the business processes and decisions most important to an organization’s success.”
“Police believe the real winner is a frequent player who purchased the ticket at a favourite store in St. Catharines in 2003, then had it checked at a Burlington store. Back at that time, there was no scanner allowing players to have their tickets checked automatically. They had to trust the clerk. Police have alleged the store’s operators lied to the customer and passed the winning ticket to a female relative to cash in.”
“Last night the largest Medicare fraud operation yet discovered was in the headlines: ‘A vast network of Armenian gangsters and their associates used phantom health care clinics and other means to try to cheat Medicare out of $163 million, the largest fraud by one criminal enterprise in the program’s history, U.S. authorities said Wednesday. Federal prosecutors in New York and elsewhere charged 73 people.’”
“After the Sept. 11, 2001, terrorist attacks, the U.S. government encouraged and funded a proliferation of domestic counterterrorism centers, commonly referred to as state and local homeland security fusion centers. Although 72 centers now exist, only 28 have privacy and civil liberties plans approved by the Homeland Security Department, National Journal has learned.”
“Worldwide Cloud Computing market is continuing to grow at a rapid rate and it is expected to cross US$ 25 Billion by the end of 2013. The different segments of the Cloud Computing market (SaaS, PaaS, IaaS) show different maturities and adoption levels. The various segments within the SaaS market will grow at a different rate.”
“Secure Flight watch list matching takes a matter of seconds to complete, and providing this data enables passengers to print their boarding passes at home or at an airline kiosk, TSA notes. The November 1 deadline marks the end of the year-long grace period for airlines to clear out their systems of older reservations made before Secure Flight requirements took effect in October 2009. After November 1, 2010, Secure Flight will not conduct watch list matching or approve the issuance of a boarding pass by an airline if complete passenger data is not submitted, the TSA says.”
Last night the largest Medicare fraud operation yet discovered was in the headlines:
A vast network of Armenian gangsters and their associates used phantom health care clinics and other means to try to cheat Medicare out of $163 million, the largest fraud by one criminal enterprise in the program’s history, U.S. authorities said Wednesday. Federal prosecutors in New York and elsewhere charged 73 people. Most of the defendants were captured during raids Wednesday morning in New York City and Los Angeles, but there also were arrests in New Mexico, Georgia and Ohio.
The latest installment in this ongoing saga includes billing for unnecessary and never performed procedures, stolen identities, and phony clinics:
The defendants in the New York case also had stolen the identities of doctors and set up 118 phantom clinics in 25 states, authorities said. The names were used to submit fake bills for care that was never given, they said.
How can those responsible for payments not detect phony clinics? Many sources of public and private information are available to validate their existence, yet apparently systems to perform this function are not in place 45 years after Medicare was created. As Mike Shultz said here in a June post:
Honest suppliers stand by helplessly as competitors cash in on the bonanza. One such supplier wrote in a guest post about how current detection methods are inadequate and how the problem can be attacked with the right technology.
Several months ago I asked the question, that if “every day, identity resolution software screens every airline passenger on every U.S. domestic flight to prevent known criminals and terrorists from boarding airplanes without being detected,” then “could the same technology be used to make the whole Medicare and Medicaid infrastructure more proactive in preventing fraud?” The answer is still “yes.”
“Beginning in 2015, providers who have not successfully demonstrated meaningful use will face cuts in the amount of Medicare reimbursement they receive. It will begin with 99-percent payment in 2015, and drop to 97 percent by 2017, according to information from the Centers for Medicare and Medicaid Services. ‘So if your practice has not implemented an EHR and have meaningful use, you’re going to get reimbursed less dollars for the same service as someone who does,’ Brull said.”
“‘Information is being created faster than organizations can make sense of it,’ he says. The gap between the growth of information and understanding is widening because the tools for understanding are not scaling as fast as the growth in data and information. ‘As computers are getting faster and the world is getting more sensors, the organizations have been getting dumber,’ he said. ‘The percentage of what is knowable is on a decline.’”
Infoglide Software provides entity resolution and analysis solutions for retail, banking, insurance, government, and law enforcement. Without the need for data cleansing or warehousing, Infoglide Software's Identity Resolution Engine™ (IRE) analyzes all of the information relating to individuals and/or entities from multiple sources of data and then applies...
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